AccountId: 011433970860
ContactId: b5a9e0f0-d580-4187-bba5-bd4ba9d7dc16
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328760 ms
Total Talk Time (AGENT): 94691 ms
Total Talk Time (CUSTOMER): 105772 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/b5a9e0f0-d580-4187-bba5-bd4ba9d7dc16_20250116T16:30_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling with Support Plus on a recorded line at the request of Doctor.
[CUSTOMER][NEUTRAL] [PII]'s office to verify benefits and eligibility for [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] Uh, that is gonna be 02123377 M for Mike, L for Lima, and 8.
[AGENT][NEUTRAL] And your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] Thank you, and I apologize, what was your name again?
[AGENT][NEUTRAL] It's [PII], first initial of my last name is [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] All right, can you verify the patient's name and date of birth for me?
[AGENT][NEUTRAL] Well, you gave me the date of birth.
[CUSTOMER][NEUTRAL] Uh, sure, that's gonna be [PII].
[AGENT][NEUTRAL] I'm sorry, you gave me the date of birth, the name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you for that.
[AGENT][NEUTRAL] So I'm showing an effective date of [PII].
[AGENT][NEUTRAL] I show the policy is active at this time and then you did say this is for service in a doctor's office?
[CUSTOMER][NEUTRAL] Yes, um, and let me provide you the codes and that's pretty much because I called earlier but I forgot to get the codes, um, it may be the same benefits, um, but, uh, we are required to provide the codes to see if there is a.
[CUSTOMER][NEUTRAL] Uh, different coverage and, uh, let's see, the procedure code is gonna be J0897.
[CUSTOMER][NEUTRAL] And the administration code is 96372 and primary diagnosis code of M81.0.
[AGENT][NEUTRAL] OK, so there is a treatment writer, uh, under this policy, um, so when covered treatment is performed, um, we can review it for consideration of benefits under the outpatient benefit which is up to $2000 and that is per calendar year.
[AGENT][NEUTRAL] And the information provided is verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'll check to see if any of that has been used.
[AGENT][NEUTRAL] Do not show that benefit has been used at this time. Any other questions?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Thank you for that. So just to confirm for the uh codes that I provide you, the code and the administration, it will be covered at 100% up to $2000 if.
[CUSTOMER][NEUTRAL] A.
[AGENT][NEUTRAL] Um, I can't I can't guarantee anything, um, and especially the administration code code, the injection code, yes.
[AGENT][NEUTRAL] Because that's the treatment, but to administer that injection, I'm not for sure if that is covered, but you can go ahead and submit the CMS 1500 and it can be reviewed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, thank you for that. OK, and uh is there a reference number for our call?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference. Uh, the first initial of my last name is [PII], and did you have any other questions I can assist with today?
[CUSTOMER][NEUTRAL] Uh, that, oh, yes, um, and you will coordinate with the primary payer. Um, would you consider the leftover deductible and co-insurance or is it just the co-insurance?
[AGENT][NEUTRAL] Mhm, um, this policy will assist with the amounts applied towards the major medical deductible co-insurance and co-pay of covered charges.
[CUSTOMER][POSITIVE] All right, thank you. All right, that is basically it. Thank you so much for your uh assisting me today and you have a great day.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Goodbye.